Washington, D.C., —A new report released today by the American Cancer Society Cancer Action Network (ACS CAN) and Georgetown University Center on Health Insurance Reforms shows that while opportunities for coverage have improved, cancer patients still struggle with significant financial challenges in affording their treatment despite substantial reductions in out-of-pocket costs and patient protections under current law.
The report, Navigating the Coverage Experience and Financial Challenges for Cancer Patients, surveyed more than a dozen hospital and health-system financial navigators at 11 hospitals across nine states. Financial navigator staff work with cancer patients to review their coverage options and obtain treatment. They are typically trained social workers or nurses.
According to the report, patients’ ability to access comprehensive health coverage has significantly improved since the passage of the health care law. Financial navigators can enroll uninsured patients in individual coverage that was previously unavailable and current law helps make individual market coverage more affordable through subsidies and tax credits. However even with improved access to coverage, costs related to using the coverage—like deductibles, co-pays and co-insurance—remain a constant challenge.
Out-of-pocket caps of more than $7,000 for an individual or $14,000 for a family provide security from catastrophic expenses, but are often difficult for patients to meet in a short amount of time. Patients and financial navigators also often find it difficult to determine what a procedure will cost ahead of time.
Navigators report that while most cancer treatment is now covered by insurers, plans are increasingly implementing medical management requirements for patients. Those requirements include prior-authorizations or step-therapy, where a patient must take a less-expensive drug before trying a more expensive prescription. These requirements pose additional burdens on patients as they work to access timely and effective treatment.
“The current health law has greatly improved access to meaningful health coverage for cancer patients, survivors and all those with chronic diseases,” said Chris Hansen, president of ACS CAN. “Yet costs remain a challenge for those facing cancer. Our country and our lawmakers should come together to find bipartisan solutions that begin to address patient costs without sacrificing the quality of coverage,” said Hansen.
Current proposals before Congress threaten to erode patient protections and shift additional costs to consumers with much higher deductibles and out-of-pocket costs. In addition to substantially lower premium tax credits and eliminating cost-sharing subsidies, these proposals would also allow a return to potentially bare-bone insurance benefits that pose a significant risk to cancer patients and their families.
Financial navigators were interviewed for the report in January and February of 2017 in California, Colorado, Illinois, Massachusetts, Michigan, Pennsylvania, South Carolina, Tennessee and Wisconsin.
Read the full report.